Medical History Form

Applicable law: any dispute resulting from or in relation to the treatments at OREME shall be resolved under Belgian law. The responsible courts shall be those of St. Vith, Belgium.
Responsible regional medical chamber: Ordre des médecins - Conseil national; Place de Jamblinne de Meux 34-35, 1030 Brussels, Belgium; Tel.: +3227430400, Fax: +3227353563.
Applicable professional regulations: https://www.ordomedic.be/fr/code/contenu/

REGARDING INSURANCE
Your contract for your health insurance has been concluded between you and your insurance company. We are not a contracting party thereto. The services that you receive and the bills you have to pay are part of your agreement exclusively between you and OREME. It is your responsibility to ensure that your bills are paid in full.

Agreements with insurance companies vary greatly and we expressly point out that not all of them are or will be able to reimburse the costs of our treatment. In order to avoid any misunderstanding or false expectations, we ask you to clarify with your insurance company in advance of your treatment any possibility of cost reimbursement. Please note that some treatments offered by OREME may be considered as not necessary by your insurance company.

USUAL AND CUSTOMARY RATES
Our pricing is calculated to ensure the highest quality of treatment. The price for a Skype consultation is a flat rate of € 200. For the in-person consultation patients are charged a flat rate of € 350. The costs for additional therapies (i.e. regenerative procedures) will be explained to you in advance thereof.
The desired consultations and treatments on weekends or during Belgian public holidays are charged with a 300% surcharge.

PAYMENT FOR SERVICES
(1) The payment for the Skype consultation takes place in advance of the consultation.
(2) The payment after the usual consultation is made immediately thereafter.
(3) 50% of the amount set for the procedure is paid at least two weeks in advance. The remaining amount is payable directly after the procedure.
Payments are accepted by PayPal, credit card, cash or by bank transfer with the name of the patient mentioned in the reference to the following account:
KBC, IBAN: BE49 7360 34105971, BIC/SWIFT: KREDBEBB

NO SHOW & LATE CANCELLATION
Consultation cancelation fee:
Our financial policy requires 48 hours notice if you are unable to make your appointment. If no notice or less than 48 hours’ notice is given, there will be a € 200 fee for consultation.
Treatment cancelation fee:
From 14 days prior to the procedure date and onwards: 25% of the treatment price will be charged as a cancelation fee.

This payment arrangement will be valid for one (1) year from today’s date, and will need to be renewed annually.